The World Health Organization will miss its 3 by 5 Initiative target of treating three million HIV-positive people in developing countries with antiretroviral drugs by the end of this year because of a lack of cooperation and coordination internationally and a lack of national leadership, according to a report released on Monday by a coalition of HIV/AIDS treatment advocates, the New York Times reports (Altman, New York Times, 11/29). The International Treatment Preparedness Coalition, a group of 600 treatment advocates from more than 100 countries, produced the report, titled "Missing the Target -- A Report on HIV/AIDS Treatment Access from the Frontlines," which aims to identify challenges to treatment access and provide solutions to overcome them (ITPC release, 11/28). Although the exact number of people receiving antiretroviral drugs in developing countries will not be announced by WHO until early next year, WHO HIV/AIDS Department Director Jim Yong Kim on Monday apologized for the organization's failure to meet the 3 by 5 target. A WHO progress report on the initiative released in June said that about one million HIV-positive people in developing countries are receiving antiretrovirals (Kaiser Daily HIV/AIDS Report, 11/28).

Report Findings
The ITPC report -- which based its findings on an analysis by people living in communities in the Dominican Republic, India, Kenya, Nigeria, Russia and South Africa -- found that less than half of the HIV-positive people who need antiretroviral drugs worldwide are receiving them, the AP/Las Vegas Sunreports. In addition to lack of cooperation and leadership, stigma surrounding HIV/AIDS, bureaucratic delays, inadequate funding and lack of knowledge about treatments also have hampered access to treatment (Leonard, AP/Las Vegas Sun, 11/28). Some countries have failed to create synchronized health care systems, as well as failed to detect and treat people co-infected with HIV and tuberculosis, according to the report (New York Times, 11/29). Specifically, the report found an absence of a national treatment plan, an ineffective treatment system, and a lack of national leadership and collaboration among providers in Russia; conflicts between agencies and bureaucratic delays that held up implementation of a Global Fund To Fight AIDS, Tuberculosis and Malaria grant in the Dominican Republic; widespread discrimination and stigma surrounding HIV-positive people in Kenya; long travel distances for treatment and a lack of funding in India; a lack of human resources and funding in Nigeria; and a government in South Africa that "continues to drag its feet and fails to combat misinformation and pseudo-science" (ITPC release, 11/28).

Conclusions, Reaction
Despite WHO's missed 3 by 5 target, the report praises the organization for its "bold efforts," the Times reports. However, the report says that in order to achieve a pledge made by leaders of the Group of Eight industrialized nations to provide universal HIV/AIDS treatment access by 2010, "a much more systematic approach to setting goals, measuring progress, and assessing and addressing barriers" to treatment access needs to be implemented (New York Times, 11/29). ITPC spokesperson Chris Collins said that coordination among U.N. agencies is critical, and he added that UNAIDS "is well-placed to do it." The agency is convening a meeting on HIV/AIDS treatment options in January (Quinn, Reuters, 11/28). The approach to providing access recommended by the group includes country-specific strategies, goals that include strict timelines and milestones, clear assignments of responsibilities, elimination of bureaucratic holdups and increased cooperation. In addition, the report says that national governments "must be the primary engine for increasing access to care," specifically calling on African countries to live up to a 2001 pledge to devote 15% of their budgets to HIV/AIDS and other health issues. "The delivery of antiretroviral therapy will only be possible with a revolution in global public health, which makes primary care available to those who have never had it before," the report says, adding that success in HIV/AIDS treatment "will pave the way for treatment of many other diseases that are now left untreated" (New York Times, 11/29).

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